


A case study detailing the voice therapy treatment of one Stanley R. Kowalski

by Seascribe



Category: due South
Genre: Documentation, M/M
Language: English
Status: Completed
Published: 2013-12-08
Updated: 2013-12-08
Packaged: 2018-01-03 23:24:25
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 1,447
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1074274
Author URL: https://archiveofourown.org/users/Seascribe/pseuds/Seascribe
Summary: <blockquote class="userstuff">
              <p>" Mr Kowalski sought medical attention as a result of increased hoarseness and effortful speaking beginning in September."</p>
            </blockquote>





	A case study detailing the voice therapy treatment of one Stanley R. Kowalski

**Author's Note:**

> I'm getting my masters in speech pathology, and for my voice class, we were assigned a laryngeal pathology (in my case, chronic laryngitis secondary to laryngopharyngeal reflux) and required to write a case study. I chose to do mine on Ray Kowalski, who with the yelling and the smoking and the drinking and the crazy high stress job and the living off of take away is a PERFECT candidate for a fucked up voice. 
> 
> This is a slightly edited version, where I have redacted the boring instrumental assessments and the therapy progression because those things are hella boring. But everything else is the same as what I submitted, except for the dates, which I had to shift forward a couple decades in my report so they made sense. Actually, in the 90s most of this technology was still only just coming into use. Ignore that.
> 
> Also, I successfully worked a Fraser-blowjob-joke into this thing and I think I might be more proud of that than of anything else I have accomplished during my time in graduate school so far. 
> 
> I got a 98% on this assignment.

**History of the problem**  
Mr Stanley Kowalski, a 38 year old police officer, was referred by Dr Gustafson for evaluation and treatment following a diagnosis of laryngopharyngeal reflux. The otolaryngologist prescribed an over the counter antacid and a proton pump inhibitor (PPI). Mr. Kowalski reported periodic hoarseness over the course of the last 18 months, worsening significantly in the last six months. Additional complaints noticed in the last six months include laryngeal fatigue and aching after extensive voice use and difficulty shouting. Mr Kowalski sought medical attention as a result of increased hoarseness and effortful speaking beginning in September. He reports that his voice quality tends to remain hoarse, however by the end of the day, the degree of hoarseness typically has increased and talking is more effortful. His vocal difficulties negatively impact his career, as he frequently has to shout on the job and often talks to co-workers over the background noise of a crowded police station. Mr. Kowalski appears motivated to resolve his vocal difficulties in order to maintain his professional performance.

 **Medical history**  
Mr. Kowalski had his tonsils removed in an outpatient procedure in 1972 and reports no other surgeries. He was hospitalised in 1974 for a fractured ulna caused by a bicycle accident and again in 1993 for treatment of a broken ankle, sustained while chasing a suspect on foot. His most recent hospitalisation was in 1995 for treatment of a concussion and mild lacerations, both sustained on the job. No other hospitalisations are noted. No injuries to the head, neck, or throat were reported. He is currently on no prescription medications besides the PPI, although he reports frequent use of ibuprofen to manage muscle and joint pain and tension headaches caused by on the job physical exertion and stress. He reports no difficulties with respiration or swallowing. Mr. Kowalski is a long-term smoker, reporting smoking at least one pack daily for the last twenty years, except for a ten-month period earlier this year when a special assignment for his job required that he quit. He indicated that personal and job related stressors had recently led him to start smoking again, but that he was trying to quit for good. Currently, he is down to half a pack a day. He describes his alcohol consumption as "moderate," consisting of 5-7 drinks during the week. His other liquid intake consists primarily of four to six cups of coffee daily. Mr. Kowalski reports that he feels "pretty good" on a day to day basis.

 **Social History**  
Mr. Kowalski has been employed by the city police department for the last 19 years, and has worked as a plainclothes detective for the last twelve years in various precincts around the city. He described the job as stressful and expressed some frustration with the bureaucratic aspects of his job, but on the whole reported that he found his career interesting and worthwhile and that he "wouldn't change now even if he could." He admitted to spending a significant portion of his day talking to coworkers over noise, with occasional periods of sustained shouting related to pursuit, arrest, and detainment of suspects. He noticed that his hoarseness and laryngeal fatigue were worse after days when he had done a lot of shouting. At the time of the evaluation, Mr. Kowalski lived alone, having been divorced by his wife of twenty years last March. He appeared reluctant to dwell on this topic, and became noticeably agitated and distressed when the subject was mentioned. He reported simply that the separation was "amiable." Mr. Kowalski reported that work took up most of his time, but that he was an infrequent member of the police precinct bowling league and that he enjoyed ballroom and Latin dancing "when I have a partner." He reported occasional social outings to bars and dance clubs, but most frequently socialized with his police partner, usually dining out or spending time at home catching up on paperwork or watching television. He was an avid fan of the Chicago Blackhawks and the Cubs and admitted to some shouting at the television during games. He also attended games semi-regularly, where he admitted to enthusiastic vocal support and heckling. Occasionally, he suffered almost complete loss of his voice after attending these sporting events. Mr. Kowalski did not feel that his vocal difficulties severely inhibited his enjoyment of social activities, but he expressed a desire to stop losing his voice so frequently and to solve the problems hoarseness, fatigue, and voice loss were causing in his professional life.

 **Voice assessment**  
[blah blah blah, perceptual auditory evaluation, blah] Mr. Kowalski completed the Voice Handicap Index (VHI) self-assessment (Jacobson et al., 1997). He reported that he almost always experienced strain producing voice, that his voice sometimes gives out, and that people frequently seem irritated with his voice. His score was 59, which revealed a moderate impact of the vocal difficulties on his day to day life.  
[blah blah blah gross anatomical discussion of RayK's fucked up vocal folds under halogen and strobe on a laryngoscopy]  
[blah blah blah all the acoustic and aerodynamic measures that quantitatively describe his level of vocal fuckedupedness]

 **Impressions and Rationale for therapy approach**  
Mr. Kowalski's medical and social history are consistent with his complaints of chronic hoarseness and vocal fatigue resulting from chronic laryngitis secondary to laryngopharyngeal reflux and associated muscle tension dysphonia, exacerbated by vocal misuse and poor vocal hygiene. Therefore, a treatment program was implemented to reduce effortful voice production and tension and to increase pliability in the laryngeal mechanism through vocal function exercises and resonant voice therapy paired with a hygienic behaviour modification plan (Stemple, 2010). Additionally, counselling was provided to supplement the pharmacological management of the laryngopharyngeal reflux to ensure maximum effectiveness.

 **Therapy plan and goals**  
Mr. Kowalski received an hour of therapy per week for ten weeks. Each session consisted of keeping track of hygienic and behavioural measures that had been undertaken as part of the treatment plan and implementing the vocal function exercise interventions. Once some improvement had been noted from the vocal function exercises at week four, resonant voice therapy techniques were introduced. At the end of each session, videostroboscopic, acoustic, and aerodynamic measures of voice function were taken.  
First, it was explained to Mr. Kowalski that the habitual throat clearing that had developed secondary to irritation caused by the reflux was a contributing factor to his vocal difficulties. He expressed surprise at the frequency of the habit when it was pointed out to him, and readily agreed to get his police partner to help him replace it with the hard swallow method (Stemple, 2010). This habit replacement was successfully completed by the third week of therapy.  
Mr. Kowalski refused to entirely eliminate caffeine and alcohol from his diet, but did agree to attempt to reduce his intake and to increase the amount of water he drank daily. Coffee intake was reduced from 4-6 cups daily to 2-3 cups daily and water intake was increased to 4-6 cups daily. Alcohol intake was inconsistently reduced, varying from 3-6 drinks per week. Mr. Kowalski did not want to be referred to any smoking cessation programs, but preferred to continue attempting to quit on his own, first cutting back to a pack a week and then trying various compensation methods, including nicotine gum.  
[blah blah blah gross LPR counselling crap that RayK is totally going to be non-compliant on at least until Fraser gets on his case about it]

 **Progression of Therapy**  
[blah blah blah,RayK is skeptical and thinks voice therapy is D-U-M dumb but goes along with it anyway because I had to write this paper, boring description of therapy and progress blah]

 **Post-therapy assessment**  
[blah blah blah, perceptual voice evaluation, everything sounds so much better, yay!]  
Mr. Kowalski completed the VHI assessment a second time, and noted that his voice no longer gave out, that he no longer had to strain to produce voice, although people still sometimes seemed irritated by his voice. His post-therapy VHI score was 8, indicating minimal impact on his daily life.  
[blah blah blah, more anatomical discussion of RayK's still gross but no longer fucked up vocal folds]  
[blah blah blah, more made up acoustic and aerodynamic measures that quantitatively describe how I unfucked his voice with my super therapist powers]

 **Conclusion**  
Mr. Kowalski was satisfied by the results of voice therapy and at the follow-up evaluation two months post-treatment reported that he had successfully stopped smoking and that he no longer noticed any impact of vocal difficulties on his professional or personal life.

*

And he lived happily ever after, threatening to kick perps in the head and having lots of hot sex with Fraser, the end. :D


End file.
